Cancer Health Disparitiesin America

While great strides have been made in cancer prevention and
treatment, certain groups experience noticeably higher incidence of
certain cancers than the general population and/or suffer significantly
poorer treatment outcomes. A disproportionately higher burden of
cancer falls on racial and ethnic minorities, as well as low-income
and elderly populations. The causes of these disparities are
numerous, complex, often interrelated and only partially understood.
Chief among them are unequal access to quality health services;
different behavioral, environmental and genetic risk factors; a lack of
minority and elderly inclusion in the development of new therapies;
and social and cultural biases that can negatively alter the
relationship between patients and healthcare providers. Addressing
these persistent cancer health disparities poses a significant
challenge for researchers and policymakers.
Access and utilization of health services ranging from screening to
treatment are perhaps the most readily identifiable causes of
disparities in cancer outcomes. In the U. S., access is greatly affected
by insurance coverage, and while nationally 14% of the population is
uninsured, 37% of Latinos lack insurance, and 20% of African
Americans are uninsured (122, 123). Even when the lack of insurance
does not create a barrier to care, the availability of local providers and
healthcare facilities can create barriers. Furthermore, when care is
available, social and cultural biases can often inhibit patients from
accessing care (124), and when individuals seek care, the care they
receive can often depend on their race (125). Lastly, most cancer
therapies are derived from focused research that culminates in
clinical trials that determine whether experimental therapies should
be approved for general use, and while enrollment in cancer trials is
low for all patient groups, racial and ethnic minorities, and the elderly
are significantly under-represented in cancer clinical trials. This
means that therapies often enter widespread use without thorough
evaluation of their efficacy in all populations.

While access to healthcare can help explain differences in treatment
outcomes between certain groups, many cancer disparities emanate
from differences in cancer incidence. Groups vary in both genetic and
behavioral risk profiles, and it can often be difficult to untangle the
effects of the two since some racial and ethnic groups share not only
similar inherited genes, but also similar cultural practices like diet.
Increased access to genetic sequencing should make it easier for
future researchers to tease apart the contributions of the two.

Mutations in the BRCA genes are but one example of a genetic risk
factor that is more prevalent in a specific ethnic group than others,
which creates cancer disparities. For example, approximately 2.0-
2.5% of women with Ashkenazi Jewish ancestry have one of three
specific mutations in the BRCA1 and BRCA2 genes, which is about
five times the prevalence of this mutation in people of other
ethnicities (126). As a result of these mutations, women of
Ashkenazi Jewish ancestry are at increased risk of developing
BRCA-related cancers as compared to the general population
(127, 128).

Continued research will undoubtedly reveal other similar genetic
risk factors that disparately either drive cancer incidence or inhibit
effective treatment. Where genes are not the cause of disparities,
research will still be critical to identify causes and develop sound
evidence-based interventions to address cancer health disparities.

Asian Americans are twice as likely tosuffer from liver and stomach cancer thanthe general population.People of Ashkenazi Jewish ancestry havean increased risk of several types of cancer,including breast, ovarian, pancreatic andcolorectal cancers.African American men and women havehigher rates of colorectal cancer and aremore likely to die from it than their whitecounterparts.